| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
347 |
341 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
237 |
231 |
$10K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
40 |
39 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
235 |
234 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
78 |
69 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
56 |
56 |
$2K |
| V2025 |
Deluxe frame |
30 |
29 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
15 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
62 |
61 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
62 |
55 |
$1K |
| 92015 |
Determination of refractive state |
75 |
69 |
$959.74 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
23 |
21 |
$72.00 |